Unfortunately, doctors have a tendency to say we have done tests on you, they are all normal, therefore there is nothing wrong with you, or, worse, that it is all psychological. It is probably true that serious or life-threatening causes can be eliminated, but this overlooks

i see patients who have not any ear problem , neither any abnormality in

the MRI but still patient have BPPV .

I agree may be psychological and even some patient with nosia .

Nusrat, It is often a subjective feeling of motion or imbalance and most patients get this episodically.

Ear may not be the primary cause for this, as this can be caused by central pathology.

Central vertigo can be caused by:

• Migraine especially in younger people
• Multiple sclerosis
• Acoustic neuroma
• Tumour in the cerebellum
• TIA
• Medications esp antihypertensives

"Central vertigo can be caused by:

• Migraine especially in younger people
• Multiple sclerosis
• Acoustic neuroma
• Tumour in the cerebellum
• TIA
• Medications esp antihypertensives"

Comment

Hence central vertigo is essentially an unhelpful myth.

Hello dear colleagues

• The balance disorders that experience our dizzy patients are far most larger than vertigo...unsteadiness, drunkenness sensations, motion discomfort, motion sickness, and sometimes they can have symptoms that are not balance disorders : isolated nausea especially in the morning with improvement during the day, impairment of the vision, motion sickness...I propose that you read the article below and we could discuss about...sincerely yours
• T Richard-Vitton, MD
• Papers
• https://www.dropbox.com/s/okbnemch6k18qpt/VO_RICHARD_VITTON.pdf?dl=0
• https://www.dropbox.com/s/suiiwpv2otsvq5t/København%20Artikkel%20Repositioning%20chairs
• %20in%20benign%20paroxysmal%20positional%20vertigo.pdf?dl=0

I guess I should feel lucky when compared to your practice. I accept two patients in the morning with the complaints of vertigo. They are already scheduled for complete hearing, VHIT, cVEMP, oVEMP and VNG. Other electrophsiological studies added when seemed necessary. If the patient have negative results despite of complaints, I aske them to call back as she/he had the attack and test her with only proper tests that seemed will help in acute attack. This way patients generally feel comfortable and helps me for diagnosis.

There still have some patients in the grey region.

I completely agree with the comments above, just tried to put another perspective which may not be applied to all experts practice conditions as reaching to lab same day with the doctors visit.

"I completely agree with the comments above"

Which comments? Does central vertigo exist, or not?

Agreed comments:

1.Tests may not help in every case.

2. Central causes should also be considered

3. Vestibular Migrain may not be counted as a central cause of vertigo (it is in grey zone) but vertigo may be the result vascular problems which may cause the problems of peripheral vestibular organ (otoliths), stria etc. These are all speculations that are considered by authors in the field.

So sorry for missing a point. True vertigo is peripheral (most of the times) As Dr. Gordon pointed out isolated lesions which may be the cause of vertigo given examples. Acute Cerebellar ischemia ( I have observed once and had a chance to see immediate CT) is another cause of vertigo but it has accompanying symptoms related to brainstem, depending on the responsible vessels.

thanks for answering , i am completely agree with you .

if cervical supine have stenosis could be .i have seen in recent case .

It is accepted by some authors that cervical vertigo may be bothersome problem, however they also agree that this subject lacks evidence. They are hopeful for future studies. Depending on some of the histories we get form the patients I suspected and still call they back in acute phase. Thomas Vitton may add some for these patients

"I propose that you read the article below"

I have read these articles, but am not sure what point you are trying to make.

rule out psychological illness

The purpose of my article is to introduce a new sub-type of canaliths disorders...non-BPPV expression for the very little particles and chronic disease...with unsteadiness.

"The purpose of my article is to introduce a new sub-type of canaliths disorders..."

In other words, yet another example of a peripheral disorder, giving even less justification for assigning vertigo of unknown origin to spurious central or psychological causes?

"rule out psychological illness"

The default position for vertigo of unproven source is often that it must be 'psychological'. There should always be positive reasons for diagnosing psychogenic vertigo, though in my opinion this entity is a figment of doctors' imagination.

Searching neurological problems produced by non tubercular mycobacterium may contribute to diagnosis.The author is working on such problems where the cause of diseases are not known.

"Searching neurological problems produced by non tubercular mycobacterium may contribute to diagnosis."

But not unless any otological contribution is carefully checked.

The neurological findings, in the case referred, are very insignificant as PIL leprosy. All my cases referred to neurologist come as no neurological sign. Just examine for touch - in hands, tip of fingers and phalangeal joints; also examine the foot where one is expected to find patches of anesthesia. Indication of neuritis will be found when the radial nerve is palpated in radial groove to find light pain – indicating neuritis.

I would like to add, that one of the most usefull clinical tools in diagnosing vestibular and/or central disorsers is that we must be able to clasiffy the symptoms (including, but not only "vertigo") acording timing and triggers, like in episodic vestibular syndrome, with the different " subtypes" like triggered (BPPV or orthostatic dizziness) or spontaneous (VM / MD).

Another diagnosis that we should always keep in mind in patient with chronic history of "vestibular symptoms or dizziness" and abscence of pathological biomarkers, PPPD (wich its included in functional disorders, not psychological neither organic disroder)

"PPPD"

What is this? Are you sure this is not simply unrecognised and hence undiagnosed endolymphatic hydrops?

Postural Persistent-Perceptual Dizziness

Having read the review of PPPD, I say it is is simply unrecognised endolymphatic hydrops. Thus PPPD is aggravated by upright posture, consistent with low blood pressure, hence low perilymph pressure and hydrops. I am sure checking through the various clinical reports of PPPD, many hydrops symptoms will have been reported (eg audiosensitivity, ear pressure/blockage, etc). The clinching counter-evidence will be cases of PPPD where all hydrops symptoms have been specifically looked for and not found. Are there any such reports?